Melioidosis: time to recognize a deadly but neglected tropical disease

Melioidosis is a life-threatening bacterial infection classically characterized by pneumonia and multiple abscesses. Its known global distribution is expanding beyond known hotspots in Southeast Asia and northern Australia. Today melioidosis is estimated to account for almost 90,000 deaths per year worldwide. The disease however is so neglected that it’s missing from the WHO list of neglected tropical diseases.

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Although the melioidosis research community is small, we manage to have yearly conferences which are always full of energy and inspiring. Last August we gathered in Colombo, Sri Lanka (see picture). During this meeting, chaired by the magnificent Dr. Enoka Corea, discussions focused on ways to decrease the burden of this devastating disease. I always like the fact that, because of the relatively small scale of these meetings, basic scientists, clinicians, epidemiologists, vaccine developers, WHO representatives etc. are all together in the same room; no parallel sessions and plenty of time for in-depth interactions. The perfect environment for exciting multidisciplinary team work! Whether during the poster sessions or afterwards during an informal beer or two.

Figure 1: The 2nd South Asian Melioidosis Congress was held last August in Colombo, Sri Lanka. The conference theme was: “Unearthing a subterranean infection” (picture: Enoka Corea).

One of the favorite activities of the melioidista’s, as we call ourselves, is looking at maps and try to make the melioidosis global distribution map more accurate. Every year or so a new one is published with different colors, different shades and always up to date if a new case has been identified somewhere on the globe (in our primer Direk Limmathurotsakul made a new maps with fancy dots!).

Since melioidosis is found in equatorial areas with tropical climates, we thought that melioidosis might also be abundantly present in central Africa. This was supported by case reports from East and West Africa mostly from returning travelers who presented with melioidosis in England, France, Spain or the Netherlands. To test whether these few and isolated cases could be the result of under-recognition and un­der-reporting, the African Melioidosis Network was established by among others professor Ivo Steinmetz. As part of this project we went to the central African country of Gabon in search for melioidosis. And indeed, we did discover a novel sequence type of its causative agent, Burkholderia pseudomallei, that caused lethal septic shock and identified B. pseudomallei and B. thailandensis in the environment. Emma Birnie, a talented PhD student from Amsterdam, went onwards to Sierra Leone (see picture). These expeditions suggest that melioidosis is emerging in Central Africa but is unrecognized because of the lack of diagnostic microbiology facilities.

Figure 2: In search for melioidosis in Africa. The melioidosis search team digging holes in a rice field in central Sierra Leone. Depicted from left to right: Ali, Emma, Fodey and Lamsama (picture: Emma Birnie).

Clearly, melioidosis should be recognized as a neglected tropical disease. Efforts by the international research community are needed to raise awareness of melioidosis within the WHO and regional and local health agencies, as well as in the general public in endemic areas. More information on the International Melioidosis Society (IMS) is available at http://www.melioidosis.info. I am sure the melioidosis community is ready for it.

To read more about melioidosis, please go to Nature Reviews Disease Primers on melioidosis: go.nature.com/melioidosis or simply go.nature.com/2NCWdWy.

In the era of suppressive antiretroviral therapy (ART), HIV reservoir cells are the last hurdle in eradicating the virus. Here, we are testing the hypothesis that immunotherapy against cancer potentiates the reactivation of latently infected cells isolated from ART-suppressed individuals favoring their elimination.

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